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Medicare's Nursing Home Rating System Is Misleading, NY Times Finds

September 5th, 2014

From hotels to movies, a five-star rating denotes top quality. But this is not necessarily the case with nursing homes, according to a recent New York Times investigation. The revelation serves as a reminder that when looking for a nursing home, you should not rely solely on Medicare’s rating system to make your decision.

For the past five years, Medicare has employed a one- to five-star rating system to help consumers evaluate a nursing home's quality. The ratings are based on a facility’s performance in three areas: quality-of-care measures, nurse staffing levels and health inspection reports. Consumers can find the ratings on Medicare’s Nursing Home Compare website.

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Attorney Samantha Simmons Fredieu is an associate at Hale Ball. Ms. Fredieu graduated magna cum laude from Vermont Law School where she was the symposium editor on the Vermont Law Review, a production editor on the Vermont Journal of Environmental Law, and a member of the Moot Court Advisory Board. She has clerked for...

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New York Timesinvestigators concluded that the rating system is based on incomplete and misleading information and may be giving consumers a false sense of security. The staff level and quality statistics ratings are based largely on self-reported data that the government does not verify. The ratings also do not take into account state fines and enforcement data or consumer complaints to state agencies. In addition, the Times reports that nursing homes have learned how to "game the rating system" to boost their ratings. As a consequence, in 2013 nearly half of the nation’s 15,000 nursing homes had four- or five-star ratings, and nearly two-thirds of facilities on a federal watch list for quality nevertheless received high ratings in the self-reported areas of staffing and quality.

When Medicare unveiled its five-star rating system in 2008, ElderLawAnswers reported the concerns of Toby Edelman, senior policy attorney with the Center for Medicare Advocacy, who noted that two of three criteria used in the ratings are self-reported, "Relying on nursing homes to describe accurately how well they are doing . . . just doesn't make sense," Edelmen said at the time.

The rating system is just one factor to consider when selecting a nursing home, and it should not be the only factor. You will need to visit the nursing home and talk to residents and family members. In addition, you should check with your state’s long-term care ombudsmen to find out if there have been any complaints filed against the nursing home.